Antimicrobial Resistance Presents a Significant Threat

As scientists have been warning, antimicrobial resistance—including antibiotic resistance—presents a significant challenge when it comes to disease. The recent reintroduction in the Senate of the bipartisan-sponsored Pioneering Antimicrobial Subscriptions to End Upsurging Resistance (PASTEUR) Act draws attention to the need for federal support for the development of new antibiotics as well as heightened awareness of their proper use. A recent press briefing by IDSA addressed the crisis.

The urgency of the quest to create new drugs and rein in the use of the ones in existence has not waned, according to Vance Fowler, MD, MHS, FIDSA, chair of IDSA’s Antimicrobial Resistance Committee and professor of medicine at Duke University School of Medicine in Durham, NC. “[Antimicrobial resistance] is one of the leading threats to human health,” he said. “If anything, this COVID epidemic that we’re all suffering through underscores that point all the more because as these patients suffer through COVID, survive COVID, only to become infected with progressively more drug-resistant bacteria, there’s sort of a convergence of epidemics.”

Not only is the current pandemic providing plenty of opportunities for patients to rely on antibiotics to cure Covid-19-related infections, antibiotics are routine in modern medical procedures from chemotherapy to orthopedic surgeries to organ transplants. “All of these life saving therapies that we have around us, these marvelous interventions...all of them are girded by antibiotics,” Fowler said.

What makes antibiotics unique is their structure and usage. Because they’re used fairly infrequently and briefly, they don’t lend themselves to traditional drug pricing models. The result has been a cooling off in the antibiotic-development space, with most large pharmaceutical companies choosing to pursue other money making pathways and small pharmaceutical firms taking up the slack but often struggling financially.

The growing threat of diseases and conditions that require these antibiotics combined with a dwindling supply means the passage of the PASTEUR Act is vital, Fowler said: “In essence, what the PASTEUR Act would do would be to establish an innovative manner in which to pay for these antibiotics, delinked from the sale of those antibiotics.” The second element of the PASTEUR Act--no less critical--is the goal of fostering responsible use of antibiotics by emphasizing stewardship. This means making an effort to quantify prescribing and usage patterns for optimal results, ideally reducing the number of drugs patients take as well as their duration.

Stewardship is not just applicable to antibiotics, Fowler pointed out. “COVID emphasized the importance of stewardship not just for antibiotics but also for the emerging list of antivirals such as remdesivir and things of that nature,” he said. Patients, especially immunosuppressed ones, can be vulnerable to fungal and bacterial infections that also may prove drug resistant.

Fowler was joined during the webinar by Tori Kinamon, an MD candidate at Duke Medical School and FDA Antibacterial Drug Resistance (DOOR) Fellow. Kinamon shared that a MRSA infection in her leg during her college gymnastics days almost cost her her life. Kinamon had been placed on vancomycin to combat the infection, but needed to switch to daptomycin when her kidneys were impacted. Multiple surgeries left her relearning to walk.

“I was the healthiest I had ever been and just very nearly escaped death,” she recalled. “As rates of resistance rise, as these pathogens become more virulent, antimicrobial resistance is becoming more and more of a community threat. Many of us have had the luxury of not needing to consider it, but given the lack of an antibiotic pipeline, that’s not something we can afford to do anymore.”

One hopeful sign is the advancement of diagnostic technology that can provide clinicians with actionable data in real time to help them pinpoint exactly which infections patients have. This reduces the need to blanket an infection with a whole spectrum of antibiotics to cover all the bases. This knowledge is allowing patients to be targeted with the correct drugs at the right times, alleviating guesswork. “There’s no such thing as a perfect drug,” Fowler stated, “but for a particular patient there’s usually a drug that is perfect for them.”